Stafford I. Cohen

Fatal Myocardial Infarction in Marathon Racing

A 44-year-old trained marathon runner collapsed after completing 24 miles of the 1973 Boston Marathon. He was resuscitated from ventricular fibrillation. Death occurred after 50 days of coma. Extensive transmural anterior myocardial infarction was documented on electrocardiogram and proved at autopsy, yet the coronary arteries were free of significant atherosclerosis. We believe this report to be the first documentation of a myocardial infarction in a trained athlete while participating in a marathon. We emphasize that the relation between exertion and infarction is unknown. Advocates of long distance running for prevention of, or rehabilitation from, ischemic heart disease should be aware of this possible complication.

Medically refractory unstable angina pectoris. I. Long-term follow-up of patients undergoing intraaortic balloon counterpulsation and operation.

Of 82 patients with medically refractory unstable angina pectoris seen between October 1972 and January 1978, 60 patients underwent a combination of intraaortic balloon pump counterpulsation, cardiac catheterization and coronary revascularization. Most patients had atherosclerotic involvement of the vessels of the anterior left ventricular wall, 48 patients (80 percent) had abnormalities of left ventricular wall contraction and 22 patients (36 percent) had evidence of acute myocardial injury. One operative and one late death occurred. The perioperative infarction rate was 5 percent. Survivors, followed up for 3 to 63 months (mean 31 months), have done remarkably well; 77 percent are considered employable,and more than 90 percent are in functional class I or II.

Treatment of preinfarction angina with intraaortic balloon counterpulsation and surgery

Abstract Sixteen patients with preinfarction angina unresponsive to medical therapy were treated by Counterpulsation with the intraaortic balloon pump. Chest pain and electrocardiographic changes were abolished or significantly decreased in all but one patient. Counterpulsation reduced peak systolic blood pressure, but had little effect on pulmonary capillary wedge pressure or cardiac output. Coronary anatomy was then defined by coronary angiography. Significant obstructive atherosclerosis of the main left or left anterior descending coronary artery was present in all but one patient. All patients underwent coronary revascularization by saphenous vein aortocoronary bypass graft. Fifteen of 16 patients survived the operation. All survivors are clinically improved, and 13 are completely asymptomatic from 1 to 20 months postoperatively.

Death and near death from cardiac arrest during the Boston Marathon.

The Boston Marathon has been run for 115 years during which there were three sudden cardiac arrests. The most recent was a near death avoided by rapid cardiopulmonary resuscitation (CPR) and defibrillation. Awareness of the dangers of participating in a marathon, the risk factors associated with sudden death during competition, and the life‐saving importance of rapid CPR and defibrillation are essential for participants and event organizers. Available records and reports of the three known cases of cardiac arrest during the Boston Marathon were examined. These cases were identified by representatives of the Boston Athletic Association, which has organized each marathon since its inception. Pertinent literature was reviewed and new information was obtained during interviews of witnesses and rescuers. The data were analyzed in search of shared risk factors for cardiac arrest, death, and the optimal requirements for survival.

On the Life of Larry Graves: The First Child Ever to Have a Totally Implanted Pacemaker.

At 22 months of age, Larry Graves was diagnosed with a ventricular septal defect that carried a sentence of death in early childhood. At age 8, he had corrective surgery and became the first child in the world to have a totally implanted pacemaker. Thereafter, he was hailed around the planet as “The Boy with the Electrified Heart.”1 His is a story about a desperate patient, loving parents committed to saving their child at any cost, caring communities, pioneering doctors, and collaborating medical institutions.